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The Syndrome of Nonverbal Learning Disabilities

learning disability subtypes

Rourke (1995a) has grouped these into three major areas:

1-     neuropsychological deficits: include difficulties with tactile and visual perception, psychomotor coordination, tactile and visual attention, nonverbal memory, reasoning, executive functions, and specific aspects of speech and language

These primary neuropsychological deficits include tactile perception, visual perception, and motor coordination. In turn, these secondary deficits lead to tertiary deficits, particularly in nonverbal memory, abstract reasoning, executive functions, and specific aspects of speech and language.

2-     academic deficits: Deficits in math calculations, mathematical reasoning, reading comprehension, specific aspects of written language, and handwriting

3-     social-emotional/adaptational deficits :Social deficits include problems with social perception and social interaction. Children with this disorder are also seen as having substantially increased risk for internalized forms of psychopathology, primarily anxiety and depression. There has also been evidence to suggest a greater risk for suicide

Cognitive and Neuropsychological Performance Issues

Children with NVLD present with a wide range of visual-spatial, visual motor, sensory, and motor deficits. At the more basic levels, these deficits involve problems with visual and tactile perception and discrimination

Such children are often described as better "auditory learners" than "visual learners

they are likely to have extreme difficulty with tasks requiring them to find embedded figures (e.g., visual figure-ground on the TVPS-R) or determine the spatial orientation of lines

These abilities typically measure within the average to above average range relative to normal peers. These strengths include simple motor skills, auditory perception, simple auditory attention, and rote memory for simple verbal material. Language strengths include adequate receptive language, adequate simple verbal expression, and good phonetic analysis

Intellectual functioning

One of the most readily obvious identifying features of NVLD is a significantly higher verbal IQ score than Performance IQ score on formal measures of intelligence

 A discrepancy of as few as 10 points may be supportive if there is substantial evidence of the disorder in other domains. More typically, a VIQ-PIQ discrepancy of 15 points or more is expected.

 Executive functions and higher level reasoning

Executive functions include such higher level abilities as abstract reasoning, logical analysis, hypothesis testing, and cognitive flexibility, or the ability to "shift gears" mentally. The ability to focus, shift, and distribute attention, organize information into memory to aid learning and remembering, and otherwise regulate thought processes are also examples of executive functions.

poor performance on measures of executive functioning are not always found in children with NVLD.

 Memory functions

Significant discrepancies between verbal and nonverbal memory are also frequently observed

 greater impairments on nonverbal memory tasks as the spatial component of the task increases. For example, it is typical to find poorer performance on the Design Memory subtest than the Picture Memory subtest of the Wide Range Assessment of Memory and Learning

 demonstrate problems with more complex measures of verbal learning and memory,

Deficits in executive functions, including working memory, are hypothesized to be responsible for these difficulties on more complex verbal memory measures

A good core memory battery for assessing the presence of nonverbal learning disabilities might include the Verbal Selective Reminding Test or the California Verbal Learning Test and selected subtests of the Wide Range Assessment of Memory and Learning, particularly the Story Memory, Picture Memory, and Design Memory subtests

 Language functions

Children with NVLD usually perform well on measures of receptive vocabulary and expressive vocabulary

weakness in particular aspects of speech and language. As with right hemisphere damage individuals (Ryalls, Joanette, & Feldman, 1987), difficulties with speech prosody and problems understanding and/or expressing emotional intonation are frequently observed in the more severe cases of NVLD. Difficulties with prosody often involve monotone speech with little inflection. Because these children are often hyperverbal in social contexts, their peers frequently see them as droning on relentlessly over boring topics. The deficits these children demonstrate in nonverbal aspects of interaction directly lead to an overreliance on verbalization as a primary means of social interaction.

 Visual-spatial abilities

As already noted, difficulties with visual perception, visual processing, and visual-spatial cognitive abilities are the most prominent features in NVLD

more impairment on tasks demanding a greater degree of visual processing or involving visual-spatial demands. Measures such as the Judgment of Line Orientation Test are typically very difficult for these children

Difficulties with copying block designs are also typical.

Problems with drawing or copying are frequently observed. In addition, handwriting may often be poor, at least initially

 Sensory-perceptual and motor functioning

Difficulties with tactile discrimination, haptic discrimination, and fine motor coordination are typical

difficulty with such tasks as finger localization, fingertip number writing, tactile form recognition, and fine motor speed and dexterity on measures such as the Grooved Pegboard Test

They are frequently less coordinated with regard to gross motor activity, particularly when the development of specific skills is required

Educational and Academic Performance Issues

perform better on measures of word recognition and spelling than math. The primary reason for this is that math is more dependent on spatial and nonverbal concepts than is the case for either reading or spelling. For example, one cannot understand the concept of fractions without some mental representation of an object divided into pieces

Social Performance Issues

Because much of social communication is nonverbal, involving "body language," facial expressions, and tone of voice, individuals with NVLD are at a significant disadvantage due to their impairments in visual processing and visual-spatial perception.

They tend to miss important cues in social interaction and almost always fail to appreciate nuances in behavior and the subtle cues they may convey.

These weaknesses lead to significant deficits in social perception.

Social judgment and social problem solving are also typically impaired. Some of these impairments are a direct result of problems with perception

Interpersonal intimacy is frequently impaired, although problems forming close personal attachments may not be noticed until late childhood or early adolescence when dating begins

Difficulty maintaining meaningful friendships may also occur

lack of adaptability, respond poorly to novel circumstances. The ability to deal with changing circumstances is a fundamental aspect of social competency.

Emotional Issues

increased risk of emotional disorders

right hemisphere dysfunction (Weintraub & Mesulam, 1983), appear to be at risk for virtually all types of emotional disorders ranging from adjustment problems to active psychotic disorders

Difficulties with socialization, problems maintaining close interpersonal relationships, and the decreased likelihood of developing intimate relationships significantly contribute to feelings of low self worth

increased risk for both depression and suicide attempts relative to the normal population

Developmental Course

Acquisition of simple self-help skills is often delayed

the poor motor coordination resulting from their tactile and visual-spatial deficits increases the likelihood they will be identified as disruptive or destructive

Difficulties with daily living skills related to eating, dressing, and simple grooming may be noted

motor abilities necessary for dressing - such as fastening fasteners and learning to tie shoes - are frequently impaired. The acquisition of early preacademic skills related to coloring, cutting, and pasting is also typically delayed

demonstrate initial difficulties acquiring early academic skills. Problems with letter and number recognition, difficulty with one-to-one correspondence in counting, and problems with copying letters and numbers are common. Printing and drawing also are frequently poor

With repeated practice, most NVLD children develop normal proficiency with these types of tasks. Rourke (1995a) suggested that these children eventually acquire normal or nearly normal proficiency on these types of tasks regardless of whether or not they receive early physical intervention such as occupational therapy

difficulty getting math, reading, and writing "off the ground." It is common for them to have difficulty acquiring recognition of letters and numbers because of the inherent visual-spatial aspects involved in early acquisition. With frequent practice, they become more successful at these tasks and eventually profit from the development of the necessary symbol systems required for the early development of reading and math concepts

Difficulties with executive functioning, problem solving, and memory for more complex and meaningful verbal and nonverbal material make it difficult for them to maintain their prior levels of performance

a number of practical deficits emerge, particularly with regard to math­based survival skills related to time, money, and measurement

These children often have difficulty with the concept of time. This often applies to the calendar as well as the clock

Learning to tell time is almost always difficult, particularly on an analog clock.

These children may have difficulties naming the days of the week or months of the year in order, but typically succeed after much practice.

Problems with time management and scheduling may persist into adulthood

Their ability to recognize and discriminate coins is often slow to develop.

More fundamentally, they have difficulty acquiring money concepts. These difficulties frequently persist into adulthood and are manifest as difficulties with budgeting, balancing a checkbook, making change, and doing comparison shopping.

 Difficulties with measurement concepts are most obvious on tasks requiring estimation

their difficulties with social skills and higher level cognitive abilities frequently lead to frustration on the job or difficulty finding employment.

 Problems with planning and organizational skills can further impair their ability to function well at home and on the job.  

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